1. Technical Field
This application relates to a surgical apparatus for suturing body tissue, and more particularly to an endoscopic apparatus for closing an incision created by a trocar.
2. Background of Related Art
Endoscopic and laparoscopic surgical procedures are performed through access ports or through small incisions in the body tissue. When performed through access ports, a plurality of trocars comprising an obturator with a sharp penetrating tip and a hollow cannula are inserted through the skin and underlying tissue layers into the body cavity. The obturator is then removed, leaving the cannula positioned in the body to provide an access port to the surgical site for introduction of a variety of surgical instruments such as staplers, clip appliers, scissors, retractors and graspers to perform the surgical procedure. At the end of the surgical procedure, the cannulas are withdrawn from the body tissue leaving an opening usually ranging from 5 to 20 millimeters, depending on the size of the cannula being used.
Typically, these trocar incisions are closed by the surgeon manually suturing the wound edges. However, such suturing does not always effectively close the lowermost layers of tissue, e.g., the muscle and fascia layers, thereby providing sub-standard wound closure.
Inadequate tissue re-approximation and subsequent poor healing of trocar sites can lead to wound closure defects in the abdominal wall. Abdominal contents, often bowel or mesentery, can bulge, (i.e. herniate) through such a defect.
Several attempts have been made to design instruments to effectively and expeditiously close trocar incisions. One such instrument is disclosed in U.S. Pat. No. 5,368,601 to Sauer. This instrument contains two needles which are deployed inside the body cavity with the pointed tips facing upwardly towards the skin. U.S. Pat. No. 5,320,632 to Heidmueller discloses a wound closure instrument having a pair of needles pointed upwardly and a slidable needle shield to capture the needle tips when pulled upwardly through the skin. Another type of wound closure device is disclosed in U.S. Pat. No. 5,364,482 to Gordon. In Gordon, a pair of curved needles are deployed from the apparatus in an arcuate path to penetrate the lowermost layers of the wound.
The need exists for an improved apparatus to close trocar incisions. It would be advantageous if the device effectively closed the lower muscle and fascia layers of the wound. It would also be advantageous if the device could effectively control and ensure proper placement of the suture in the desired position.